SC210--Week 5--Lecture notes

Volti, Ch. 7, Medical & Biological Technologies

This week's theme is medical and biological technologies. We should stress the need to evaluate such technologies dispassionately and not react to new ideas out of reflex. Just because an idea is new does not mean it is necessarily a bad idea. Or a good one, either.

Yet many people do react reflexively. This is very clear in the history of hand washing in medicine. This is very simple medical technology. It is hard to conceive that anyone could ever have objected to it. But when in the late 1840s Ignatz Philip Semmelweiss observed the tremendous difference in the death rates at two maternity clinics--one staffed by physicians and medical students who would come to the mother direct from dissecting cadavers, with their hands covered with intensely septic corpse juice (no refrigerators then), and one staffed by midwives--and tried to convince the doctors to wash their hands in antiseptic, he had a hard job. Eventually the doctors gave in and tried it for six months, their death rate dropped, and they said, "There, Ignatz old boy, satisfied?" and went back to business as usual. This supposedly contributed to Semmelweiss's later insanity. Click here for the story.

To most people, "medical and biological technologies" means solely medical, but there are a great many biological technologies that are also important to our society--for two instances, agriculture and fermentation (not just beer and wine, but also bread, antibiotics, and soy sauce, among others). And both bio and med tech have a long history of development, with even the earliest stages of development representing very impressive advances. Think of the discovery that crops could be grown, that sanitation had benefits, that herbs could be used to treat various illnesses (this tech isn't even uniquely human--anthropologists have noticed chimpanzees eating exceedingly nasty-tasting [the anthropologist tried them] leaves that contained compounds that could kill intestinal worms [as revealed by lab tests]).

Today, in medicine, we're looking at much more advanced procedures such as kidney dialysis and organ transplants, which unlike antibiotics and vaccines benefit few people, are expensive, and can be seen as inappropriate in certain circumstances. Should we use them? When should we use them? When should we not use them? Volti offers four criteria (from Bryan Jennett) for judging whether technological intervention is appropriate:

Is the intervention: To translate, we should not treat if the treatment is unlikely to do any good, if it is likely to do more harm than good, if the good it does is too little, or if the resources used (including money) could be put to better use elsewhere. The last item here may seem cold, callous, unfeeling, and too darned rational, but I do think that if by letting one grandfather (even my own) go, I can save a thousand children, then I have an ethical obligation to do so. It is a sad truth that medical resources are not unlimited. Consider that some drugs can cost a patient hundreds of thousands of dollars a year!  And note the numbers given on page 126.

So far the most effective medical technologies have been the simplest and cheapest. Simple sanitation (clean drinking water, handwashing) has saved far more lives than vaccines, antibiotics, bypass operations, and so on. New technologies could conceivably change that. In Ch. 8 (next week), Volti discusses stem cells, cloning, and genetic engineering. All raise ethical issues, but stem cells raise the possibility that many handicaps will become curable conditions, genetic engineering raises the possibility that we will one day (maybe even soon) be able to change one's genes to remove vulnerabilities to disease, high blood pressure, cancer, and so on. Should we? Or do we do better to identify behaviors (such as high-fat diets, smoking, drinking, couch-potatoing) that activate those vulnerabilities and then change the behaviors?

Something that perhaps is not emphasized enough is the business of "halfway technologies." Volti mentions the term in Ch. 7, meaning technologies that keep patients alive without curing their problems. The term can also be used to refer to technologies that are not yet in their final and most useful form, such as genetic engineering or cloning. In their present form, they are alarming; if we permit them to develop, they may reach a point where the alarming features diminish or vanish and they provide huge benefits; if we ban them, we never reach the benefits stage. Right now, cloning (as with that famous sheep, Dolly) is all about whole creatures, and many people react to it very much with alarm. Yet I (as a biologist) can see the techniques developing to the point where we might be able to clone single organs, perhaps even inside the body. Stem cell research in particular may lead in that direction, giving rise to a field already called regenerative medicine.

In the Taking Sides book, our issue for the week is genetically modified foods. Are they safe to eat?  Are they better for the environment (because they need less in the way of pesticides)?  Proponents insist that they are, and that they hold immense potential for increasing food production enough to meet the needs of the growing human population (now over 7 billion, and expected to top out at about 11 billion by 2100).  Critics object that genetic engineering is not natural, it favors Big Business, and mixing genes may cause health (allergies, cancer, etc.) and environmental (super-weeds) problems.   So far research has not found any such problems, but that has not stopped critics.

Many new technologies start off with extravagant promises of benefit to humanity.  Most turn out to have unfortunate side-effects.  Sometimes the benefits seem worth the price; we are not about to give up the automobile, despite its consequent air pollution, traffic deaths, and urban sprawl.  Sometimes the drawbacks come in time to outweigh in many minds the equally real benefits, as has so far been the case with nuclear power. 

Other precedents include the Green Revolution in agriculture, antibiotics in medicine, and satellites in space technology; each of these cases was once criticized as being against nature (satellites were actually accused of causing bad weather), being inequitable (the Green Revolution favored rich farmers more than poor ones), and going against god or nature (antibiotics defy death), but in each case society decided that the benefits outweigh the drawbacks.

Do such precedents tell us anything useful?  Which precedent seems most prominent in the minds of those who object to genetically modified foods?  Which precedent seems most prominent in the minds of those who praise it?  And is the sort of genetic engineering we see here a sort of "halfway technology"?

Questions for Discussion

1. Why did people object to Semmelweiss's idea that handwashing was a Good Thing? Which, if any, of Volti's four criteria (from Bryan Jennett) for judging whether technological intervention is appropriate (necessity, safety, kindness, wisdom) were in play?

2. Halfway technologies--"halfway" in the sense that they have yet to reach their full usefulness--can seem much more alarming than useful (consider cloning and stem cells). Should their use be delayed until they are fully developed? Do you think that if their use is delayed, they will ever be fully developed? (All right, all right! Yes, this is an easy one!)

3. If genetic engineering as we know it today is a sort of "halfway technology," what is it halfway to?

4. Should regulation of a new technology be based on demonstrated risks?  On potential risks?  On the nature of the press coverage?